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OSCE Communication Skills Dr Yovisha Vijayakumar   8th April 2025ResourcesCommunication skills • Lifestyle advice   • Smoking cessation   • Alcohol history takingFormat for communication stations • Introduction • History taking • Establish the patient’s current knowledge • What are their concerns   • Risk factors • Advice • Check understanding at regular intervals • Short-term goals • Leaflets • Arrange follow up  Case 1 • Ethan is a 45-year-old who has just been diagnosed with diabetes.   • He has come in to see you for lifestyle advice and modifications.   • What are you going to do next?  Case 1 • Ethan is a 45-year-old who has just been diagnosed with diabetes. What do you think you will   advise someone who has come • He has come in to see you for in with diabetes? lifestyle advice and modifications.   • What are you going to do next?  Lifestyle Advice • Introduce yourself: • Name, Confirm patient identity • Confirm they are here for lifestyle advice   • History Taking • I see you are a newly diagnosed diabetic, what led to your diagnosis?   • Knowledge: • Do you know why you have been referred to see me? • What do you understand about diabetes   • Concerns: • Are there any concerns you have coming in today? Is there any expectations of what you will get from today?• Risk Factors & Advice • Family history • A Day in your life - In the week and on weekends. • Who lives at home with them? • Children/grandchildren • Motivation to do better • Diet • Refer to dietitian • Make meals at home, switch to healthier options like salads • Walk after meals • Work, travel • Close by - could they walk / cycle, once a week • Bus – get down a stop earlier and walk, Car – park further away • Use stairs instead of lifts • Smartwatches to track steps & remind them to exercise, Get up and move every hour    • Stress - Mindfulness (apps) • Smoking – Stop smoking services • Alcohol – Reducing alcohol services • Drugs – Refer to services   • Check Understanding • Recap the points and changes to be made   • Goals • When should they achieve this goal by? Let them suggest   • Leaflets • Follow up: In 3 / 6 months to see if he has made progress    What other scenarios can present with this? • Chronic diabetic • Hospitalisations, • complications (eyesight, nerves, kidneys), • what medications they are on, monitoring blood glucose • Sick day rules – don’t stop insulin, see a doctor early – check to understand   • Hypercholesterolemia • Pathophysiology – cholesterol deposits in blood vessels & can block it • MI, stroke, PVD – not just death but also debilitating diseases (amputation) • Avoid unhealthy fats: red meat, full-fat milk, fried food, refined sugars (cakes, cookies)  • Advice in renal failure • Low protein & potassium (mention bananas) • High potassium: nausea, vomiting, muscle weakness) • Low glucose diet (worsening of diabetes leads to poorer renal function) • Avoid large volume of fluid (1L a day) – overload, pulmonary oedema, hypertension • Keep track of input & output   • Osteoporosis • May ask you to explain DEXA scan results, explain osteoporosis (bones weak and brittle, likely to fracture) • Cause of osteoporosis (postmenopausal, high dose steroids, lack in Vit D, Fam Hx) • High calcium diet, weight bearing exercises, reduce risk of falling • Explain bisphosphonates (slow bone break down, • tablet or injection – swallow whole with water, • sit upright for 30 minutes. • SE: oesophagitis, jaw necrosis)Case 2 • Jenny has been referred to you to discuss smoking cessation options • She is hesitant to quit smoking Case 2 • Jenny has been referred to you to discuss smoking cessation options • She is hesitant to quit smoking What tips would you give someone to stop smoking?Smoking cessation • Introduction • Introduce yourself, confirm patient identity • Gain consent - “ Talk about your smoking habits & thoughts on quitting   • History taking • Current smoking habits • Age of onset, How many a day for how many years • Tried to quit, how, any success, why did you restart • Feelings about failing • Has it affected her life? - Relationships, work, health, finances    • Risk Factors & Advice • Do they want to stop smoking now • Benefits –better for health, feel better, save money • Risk for Lung Ca decreases significantly when stopped (If they ask how much and you’re not sure, provide them with a ‘leaflet’ saying the figures are there) • Dangers – Cancer, heart attack, stroke risk, COPD, harm others from secondary smoking • Reassure that it is never too late to stop • Do they have any motivations? (children / grandchildren) • Tip: Use this to try and persuade them if they are reluctant  • Assisting • Options to cut down gradually or stop immediately (“cold turkey”) • Stop smoking clinic – nurse specialist to monitor progress • Side effects of stopping – craving, irritability, tremors • If you get the temptation, keep busy – exercise, talk to family • Other options • Nicotine replacement patch / gum  - SE: Nausea, headache, palpitation • Medication – Bupropion or Varenicline - BNF • Concerns & questions ?   • Leaflets, websites – NHS, quit.org.uk • Follow – up • Reassure that they don’t have to decide today • If they want to, you can refer them to stop smoking services • Follow- up session in a month?   Case 3 • Jamie is a 35-year-old man • He was recently admitted for acute pancreatitis from alcohol consumption • You are the junior doctor and have been assigned to take an alcohol history from Jamie, as well as provide him with resources to reduce his alcohol What do you think we should include in the history? Is there a questionnaire we can use to help?Alcohol History T aking • Introduction • Patient Details • Explain purpose – regarding alcohol intake, may be difficult but you can stop at any time • Consent   • What has brought you in today? • Patient may be admitted due to cirrhosis, jaundice, liver failure.. etc • Hospital / follow-up -> what do you think is the cause of your admission? • Good for them to admit their alcohol is the cause of the problem    • 1 . CAGE screening • Cut Down • Annoyed • Guilty • Eye Opener   • 2. Alcohol Intake • When did they start, • How much did they use to drink & how much do they drink now? • Is there a reason for why it has increased? • 1st drink of the day • Drinking pattern – weekdays & weekends • Quantify & clarify – Type & how strong  • 3. Impact • Dependence • Biological – Symptoms when you stop - Nausea, Tolerance • Psychological – What do you feel when you stop?            - Why do you need to drink? • Socially • Occupation – drink at work, driving to work when intoxicated • Relationships • Living situation • Alcohol-related crimes   • Previous attempts at abstinence – when, why, why did it fail   • Tip – thank patients for sharing, ask if they are alright to continue – points for comm• 4. ‘Rest of the history • PMH – alcohol related disease – like liver problems • Drug + allergies • Family history – anyone in the family with alcohol problems • Recreational drug use   • 5. Assess risk • Mood • Depression – feeling low, low energy (anergia), lack of motivation to do things they used to enjoy (anhedonia) – Final year • Thought of self harm / hurt others • Appetite, sleeping, concentration• Ending • Leaflets !! • In Hospital – Drugs and Alcohol nurse • Outpatient – refer to Drugs and Alcohol Outpatient services • Alcohol rehab services • Alcoholics anonymous, Drinkaware (online), Drinkline (Helpline) • Medication • Disulfram – will cause unpleasant symptoms when taken with alcohol • https://bnf.nice.org.uk/drug/disulfiram.html#indicationsAndDoses • Acamproste – reduces cravings • https://bnf.nice.org.uk/drug/acamprosate-calcium.htmlWhat advice would you give him to quit drinking?  Alcohol cessation • Introduction • Introduce yourself, confirm patient identity • Gain consent - “ Talk about your alcohol habits & thoughts on quitting   • Alcohol History taking (as above but brief) • Alcohol intake, when did they start, drinking habits • Impact on day to day life • Dependence • Social • Rest of history • CAGE questionnaire• Risk Factors & Advice • Do they want to stop drinking now • Benefits –better for health, feel better, save money • Dangers – Liver failure, pancreatitis, cancer, heart disease • Reassure that it is never too late to stop • Do they have any motivations? (children / grandchildren) • Tip: Use this + CAGE questionnaire to try and persuade them if they are reluctant• Assisting • Side effects of stopping – anxiety, sweating, nausea • Acute alcohol withdrawal - Delirium tremens • NOT advised to stop alcohol ‘cold turkey’- This is usually done in hospital under specialist care   • Can cut down slowly with reducing the amount of alcohol they drink slowly • Remind it is ESSENTIAL they use other services for help • Refer to Drugs and Alcohol Outpatient services • Alcohol rehab services • Alcoholics anonymous, Drinkaware (online), Drinkline (Helpline) • Medication • Disulfram – will cause unpleasant symptoms when taken with alcohol • Acamproste – reduces cravings   • Leaflets, websites • Follow – up  - Reassure that they don’t have to decide today, Follow- up session Thank you! Feedback   https://app.medall.org/feedback/feedback-flow? keyword=3c9c633ba3ac1e6d40754f25&organisation=bitsFormat • 16 stations (Year 3 – Southampton) • 10 + 10 stations (Finals)   • 2 minutes to change station & to read the question • 7 minutes in the station (8 – 9 mins for Finals)T ypes of stations   • History taking • Southampton loves this, so make sure you practice this the most ! • Practice taking histories for 6 minutes, and save the last minute to present, and talk about differentials (In finals they expect a management plan • Examination • Practice examination in 6 minutes, • Save the last minute to present, and talk about differentials (In finals they expect a management plan  • Procedures • Venepuncture, Cannulation, IM & Subcut – if possible, it is good to borrow equipment from Uni • Blood pressure, blood glucose (unlikely), Vital signs • Catheterization (Finals - unlikely but good to know)   • Explanation • Inhalers, Peak flow, Blood transfusion • Procedures (Year 3 - OGD, Sigmoidoscopy, ERCP, Laparoscopic cholestectomy, Ultrasound, Lumbar puncture)• Data interpretation • Blood results – Anemia, Thyroid function, Urine dipstick, ABG • ECG, CXR, AXR • CT (unlikely, but if there is, they expect you to know Subdural H, Extradural H, Abscess)   • Communication • Advice – Lifestyle advice, smoking cessation • NOT the same as taking alcohol history • Difficult consultations (Final year)   Final Year additional • A – E assessment ** • Prescribing – Generic medications / emergency medications Cardio - Chest pain. - Cardiac arrest + CPR - Palpitation, Atrial fibrillation - Syncope. - Hypertension. - Pericarditis / Infective endocarditis. - Heart failure/ generalized edema/ ankle swelling. - Intermittent claudication, Acute/ chronic leg pain. - Deep venous thrombosis. - Complete cardiovascular examination - ECG interpretation. Respiratory - Asthma: in all scenarios: Acute ER setting management, Worsening follow up, After attack follow up - Pneumonia, typical and atypical. - Chest pain. - SOB - Cough. - Haemoptysis) - COPD: in all scenarios: Acute ER setting management, Worsening follow up, After attack follow up, Consult. - Pulmonary embolism. - Interstitial lung disease, occupational cough/SOB. - Pneumothorax - A-E / CXR - Sore throat. Tuberculosis Gastro - Difficulty swallowing (Dysphagia). - Nausea / vomiting. - Reflex - Upper GI bleeding. - Lower GI bleeding. - Diarrhea, acute & chronic. - Constipation. - Irritable bowel syndrome. - Inflammatory bowel disease, Crohn's & ulcerative colitis. - Diverticulosis/ Diverticulitis. - Abdominal pain. - Jaundice. - Biliary colic / Cholecystitis Endocrine - Diabetes - Hypoglycemia. - DKA - Hypercalcemia. - Abnormal lipid profile / Hypercholestrolemia - Obesity / Weight gain counseling. - Weight Loss. - Hirsutism - Galactorhea. - Gynecomastia. Neuro - Bacterial meningitis. - Unsteadiness/ Dizziness/ Ataxia. - Tremor/ Parkinsonism. - Stroke/ TIA. - Headache: all types and settings. - Temporal arteritis - Subarachnoid hemorrhage. - Seizure: attack at ER setting/ Collateral - Weakness. - Limb neurological examination. - Cranial nerves examination. - Coordination examination. Renal - Urinary tract infection - Hematuria - Incontinence - Retention – BPH, cancer - Renal failure, acute and chronic. - Erectile dysfunction. - Scrotal pain./swelling/ mass.   MSK - Back pain, acute and chronic - Cauda equina - Siatica. - Ankylosing spondylitis. - Joint pain/ any joint - Osteoarthritis. - Inflammatory arthritis/ Rheumatoid. - Septic arthritis. - Complete joint examination: Cervical and lumbar pain, shoulder, elbow, wrist, hip, knee, and ankle.   Multisystem - Fall. - Syncope / Fainting. - Fatigue / Tiredness. - Fever. - Fit - Unsteadiness / Dizziness. - Edema.   Ethics & Difficult patient - Delivering bad news: Cancer, Death. - Conversation about DNACPR - Telling the truth - mistake - Confidentiality / Breaking confidentiality –ex. STI - Capacity Assessment - Health care provider refusal to provide care ex. abortion - Domestic Abuse - Taking Informed consent. ● The Talkative patient. The Angry patient. Paeds - Fever. - Rash. - Vomiting - Diarrhoea. - Seizure; febrile and epilepsy - Cough: Asthma, viral, cystic fibrosis. / - Running nose/ ear pain. - Neonatal jaundice. - Limping child - Growth chart interpretation. - Enuresis. - Recurrent abdominal pain. Acute abdominal pain. Obs & gynae - Pelvic inflammatory disease + vaginal discharge - Sexually transmitted diseases (STD) - TV, BV, Candida / - Vaginal bleeding (Gynaecological, post-menopausal, 1st trimester, 3rd trimester). - Lower abdominal pain, acute and chronic - – gynae, early pregnancy - Nausea & Vomiting in pregnancy. - Pre-eclampsia/ Pregnancy induced hypertension. - Birth control counselling + UKMEC criteria - Pap smear counselling. - Breast nodule/ Nipple discharge/Breast exam / Explaining Self Breast exam.   Psychiatry - Depression +/- suicide - Anxiety - Manic episode. - Personality disorder/ Borderline disorder. - Psychosis, acute and chronic. - Panic disorder. - Dementia (Forgetfulness). - Delirium (Confused). - Anorexia nervosa. - Mini-mental state exam/ Complete mental exam. - Alcohol abuse/ withdrawal/ Alcohol cessation planning. - Drug abuse (Pain killers and street drugs), Cocaine Intoxication